Chondromalacia patella is a common cause of
kneecap
pain or
anterior
knee
pain.
Often
called
"Runner's
Knee,"
this
condition
often
affects
young,
otherwise
healthy
athletes.

Chondromalacia is due to an irritation of the
undersurface
of the
kneecap.
The
undersurface
of the
kneecap,
or
patella,
is
covered
with a
layer of
smooth
cartilage.
This
cartilage
normally
glides
effortlessly
across
the knee
during
bending
of the
joint.
However,
in some
individuals,
the
kneecap
tends to
rub
against
one side
of the
knee
joint,
and the
cartilage
surface
become
irritated,
and knee
pain is
the
result.

Chondromalacia
is due
to
changes
of the
deepest
layers
of
cartilage,
causing
blistering
of the
surface
cartilage.
The
pattern
of
cartilage
damage
seen
with
chondromalacia
is
distinct
from the
degeneration
seen in
arthritis,
and the
damage
from
chondromalacia
is
thought
to be
capable
of
repair,
unlike
that
seen
with
arthritis.

Chondromalacia
is
interesting
in that
it often
strikes
young,
otherwise
healthy,
athletic
individuals.
Women
are more
commonly
affected
with
chondromalacia.
Exactly
why this
is the
case is
unknown,
but it
is
thought
to have
to do
with
anatomical
differences
between
men and
women,
in which
women
experience
increased
lateral
forces
on the
patella.

The
treatment
of
chondromalacia
remains
controversial,
but most
individuals
can
undergo
effective
treatment
by
resting
the knee
and
adhering
to a
proper
physical
therapy
program.
Allowing
the
inflammation
of
chondromalacia
to
settle
is the
first
step of
treatment.
Avoiding
painful
activities
that
irritate
the knee
for
several
weeks,
followed
by a
gradual
return
to
activity
is
important.
In this
time,
cross-training
activities,
such as
swimming,
can
allow an
athlete
to
maintain
their
fitness
while
resting
the
knee.
The next
step in
treatment
is a
physical
therapy
program
that
should
emphasize
strengthening
and
flexibility
of the
quadriceps
and
hamstring
muscle
groups.
Use of
nonsteroidal
anti-inflammatory
medication
is also
helpful
to
minimize
the pain
associated
with
chondromalacia.
Treatment
with
surgery
is
declining
in
popularity
for two
reasons:
good
outcomes
without
surgery,
and the
small
number
of
patients
who
actually
benefit
from
surgical
treatment.

Is surgery necessary for chondromalacia?
Sometimes
chondromalacia
is not
cured by
conservative
therapy,
and it
may be
determined
that
surgery
is
needed
for
definitive
treatment.
By
looking
into the
knee
with an
arthroscope,
the
surgeon
can
assess
the
damage
done to
the
cartilage.
He or
she can
also
assess
the
mechanics
of the
joint to
ascertain
if there
is an
anatomic
misalignment
that
could be
corrected.

One common misalignment is due to abnormal
tracking
of the
patella
(tracking
is
simply
the
movement
of the
patella
as the
knee
moves)
caused
by tight
tissue
on the
outside
(lateral)
of the
kneecap.
For this
problem,
a
procedure
known as
a
lateral
release
can be
performed.
The
lateral
release
involves
cutting
the
tight
lateral
ligaments
to allow
for
normal
position
and
tracking
of the
patella.
If this
is not
sufficient
to
correct
the
misalignment
there is
more
extensive
surgery
that can
be
performed.